Responding to the Increase in Substance Use, HIV, HCV, and Overdose in New England (RISE-NE) - Background: Despite the availability of robust substance use prevention and treatment services in some communities, sizable HIV outbreaks are occurring among people who use drugs (PWUD) in New England. High levels of opioid use, early introduction of harmful drug supply contaminants, and increasing polysubstance use involving stimulants have led to intersecting epidemics of HIV, HCV and overdose. Prevention services (e.g., syringe service programs, HIV testing) have been available in parts of New England for decades, yet significant service delivery gaps exist outside of major metropolitan areas and for certain groups of PWUD, who face heightened barriers to accessing services. Overview of Proposal: In response to RFA-DA-25-003, our highly qualified, interdisciplinary team proposes the “Responding to the Increase in Substance Use, HIV, HCV, and Overdose in New England” or RISE-NE cohort, which will be the first of its kind to systematically examine rapidly evolving HIV and substance use trends in New England. With the ultimate goal of informing the scale-up of evidence-based HIV prevention and treatment services for PWUD, we will leverage our extensive community-research partnerships to recruit a cohort of 1,200 PWUD (including 15% living with HIV) in the New England states of Rhode Island, Massachusetts, and Vermont. Informed by a multilevel framework for HIV, HCV, and substance use outcomes, we will conduct biannual visits over five years involving behavioral assessments and biospecimen collection (e.g, HIV & HCV testing/labs). Overview of Aims & Approach: Using data from the RISE-NE cohort, we aim to: 1) examine trends in rapidly evolving substance use patterns using multi-state, time-homogeneous Markov models, and evaluate the multilevel determinants (e.g., urbanicity) of substance use trajectories using multilevel growth mixture models; 2) evaluate multilevel determinants of access to and quality of services along the HIV, HCV, and overdose continua of care; 3) evaluate the population-level causal effects of potential policy changes and interventions on our primary HIV, HCV, and outcomes using g-methods; and 4) rapidly address current and emerging research priorities, including the effect of HIV-associated comorbidities (e.g., cognitive functioning, mental health disorders) on care continua outcomes. Plans for Community Engagement and Supporting NIDA’s HIV Cohorts Program: We have strong support and engagement from numerous community partner agencies across all three states; additionally, our Community Leadership Council will convene quarterly to advise us on all aspects of our research. Finally, RISE-NE will serve as a critical resource for NIDA’s HIV Cohorts Program and an unparalleled training platform for new investigators.
